The Trump administration is limiting scientific input to the 2020 dietary guidelines, raising concerns among nutrition advocates and independent experts about industry influence over healthy eating recommendations for all Americans.
For the first time, the Department of Health and Human Services and the Department of Agriculture, which oversee the committee giving recommendations for the guidelines, have predetermined the topics that will be addressed. They have narrowed the research that can be used only to studies vetted by agency officials, potentially leaving key studies out of the mix.
The 80 questions the committee has been asked to answer do not cover several pressing issues the panel explored five years ago. This includes the consumption of red and processed meat, as well as the dramatic proliferation of ultra-processed foods, which account for a growing percentage of calories consumed by Americans. Nor will the committee explore appropriate sodium levels for different populations.
A wide range of experts say these are among the most critical questions as the nation faces an epidemic of lifestyle diseases such as atherosclerosis, heart disease, stroke, obesity and Type 2 diabetes. They also represent the issues that large food companies find most objectionable because they would likely cast high-sodium, high-sugar, high-saturated fat and highly processed foods in a poor light.
Since 1980, the federal government has revised dietary guidelines every five years, and the recommendations have a wide impact on American health and commerce. The guidelines, their CliffsNotes version once known as the food pyramid, are the road map to how the government administers school lunches as well as food assistance programs. And many manufacturers formulate their products based on these guidelines so they can participate in those programs, which buy $100 billion of food a year.
Half of American adults already live with one or more diet-related chronic illnesses, and poor diet is the No. 1 cause of ill health in the country, leading to 700,000 deaths annually, according to the Center for Science in the Public Interest, a consumer advocacy group that pushes for safer and healthier foods.
Even if the debate around issues such as red meat and salt remains unresolved, leading nutritionists say it is hard to fathom why the federal panel wouldn't try to assess the evidence and craft recommendations.
"The cutting-edge issues in dietary advice in 2019 are about eating less meat, avoidance of ultra-processed foods, and sustainable production and consumption," says Marion Nestle, a nutrition scholar at New York University. "Guidelines that avoid these issues will be years behind the times."
In a statement, the USDA confirmed that topics not listed among its 80 questions will not be addressed.
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It said it decided on the topics based on their importance to public health, potential impact on federal nutrition programs, and to avoid duplication of federal efforts. The committee will look at broad questions exploring the relationship between added sugar consumption and the risk of obesity, as well as more specific questions, such as the relationship between seafood consumption during pregnancy and lactation and the cognitive development of the infant.
The work of the 2020 Dietary Guidelines Advisory Committee has added import this cycle. For the first time, the committee will issue nutrition guidelines for pregnant women and children under 2 years old. In addition, the World Resources Institute, the World Bank and United Nations issued a report recently that humans must dramatically alter food production to prevent the most catastrophic effects of global warming, one of its central imperatives reducing demand for beef.
Under a 2015 law passed by Congress in response to that year's recommendations, this year's panel is prohibited from studying the impact of food production on the environment.
"The dietary guidelines are under assault from multiple directions," David Katz, author and founding director of Yale University's Yale-Griffin Prevention Research Center, said in an email. "This time around, veiled organizations representing the interests of beef, dairy and Big Food are pretending to use science to argue against the actual science and to expunge key recommendations. Of course sustainability should be included. Of course we need to eat less meat."
Danielle Beck, senior director of government affairs for the National Cattlemen's Beef Association, defended the USDA's approach, saying it preserves the scientific integrity of the dietary guidelines process.
"It's important to note that the guidelines were never intended to talk about sustainability; those questions are outside the scope of law," she said. "We're confident that as long as the research is clear, and as long as the committee sticks to the scope laid out for them, it will acknowledge beef's role in a heart-healthy, balanced diet."
As it conducts its research, the dietary guidelines committee has historically cast a broad net to craft its recommendations, consulting with outside experts and drawing on data analysis, the USDA's own research and outside science from universities and independent researchers.
Some experts argue the decision to limit the work only to research analyzed by the agency's own scientists will hobble the committee. On July 22, more than 30 advocacy groups and organisations, from the American Institute for Cancer Research to the American Academy of Pediatrics, petitioned the advisory committee to open up the process.
The group says that the decision to exclude outside science will reduce the effectiveness of review and represents a sharp departure from the process used by the 2015 committee, which used outside science to answer nearly half of its research questions.
"Thousands of researchers outside the federal government have devoted their careers to conducting valuable research on topics related to diet and health, including some of the specific research questions identified by the [committee]," the letter says. "This research, which includes systematic reviews and meta-analyses, has been peer-reviewed by the country's - and the world's - leading researchers in the field and published in the top scientific journals, at scientific conferences and on the websites of respectable nonprofit organizations. "
Some experts say that because the USDA has explicitly prohibited research conducted before 2000 from being considered, much of the strongest science-based advice on dietary fats and cardiovascular disease risk will be excluded. And for establishing guidance for the feeding of babies and toddlers, renowned experts have collaborated on guidelines - for example, on the role of breast-feeding in infant nutrition - that will be ineligible for consideration because they aren't the USDA scientists' own systematic reviews.
Donald Trump. Photo / AP
"Why ignore all this work already being done?" asked Bonnie Liebman, director of nutrition for the Center for Science in the Public Interest. "My guess is the USDA wants to control the evidence that can be examined by the new advisory committee. By excluding existing reviews, it can essentially ignore all of the previous reviews that made meat, dairy and sugary drinks look bad."
In a statement, the USDA said its own reviews "will capture all relevant research studies that pertain to the specific scientific question being answered." On its website, the USDA notes that outside science may not use the same rigorous standards, may be out of date or have different outcomes than government work. And it cited a recent National Academies of Sciences, Engineering, and Medicine report as its justification for the decision to not use outside science.
But the report does not suggest the committee restrict its science in this way.
"With limited resources, it would be advantageous to leverage existing systematic reviews, meta-analyses, and reports to minimise unnecessary replication of efforts and to share results with others," it reads, concluding with, "the use of existing systematic reviews and meta-analyses is encouraged."
Jerry Mande, a nutrition science and policy professor at Tufts who was at the USDA during the Obama administration, said some of the USDA's actions might make sense - for example limiting outside science to make sure research is unbiased. But he said it's hard to tell the USDA's motive given other anti-science actions taken by the administration.
It has taken other pro-industry moves, for example, such as relaxing restrictions on processed foods and sodium levels in the school lunch program.
"The question is, is [USDA] promoting science or restricting science?" Mande asks.
Others defend the administration's decision to rely on internal science.
Nina Teicholz, the author of "The Big Fat Surprise," which challenges whether saturated fat causes heart disease, a matter of ongoing nutritional debate, argues the dietary guidelines process has long had a problem of relying on outside science that may be influenced by industry.
"There has been an effort to portray [the 2020] guidelines as a product of Trump's anti-science policies," Teicholz wrote in an email. "However, the problems have been an issue for the guidelines going back to their launch in 1980. "
Some independent experts say the USDA's recent decisions reflect industry pressure and controversy that surrounded the 2015 dietary guidelines.
That year's committee, for the first time, proposed strict limits on added sugar (no more than 10% of total calories), identified a strong correlation between the consumption of processed and red meat and certain kinds of cancer like colorectal, and suggested addressing diet and sustainability (what is good for human health as well as planetary health). The North American Meat Institute, the National Cattlemen's Beef Association, the dairy industry and other influential stakeholders pushed back strongly.
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"This caused a ruckus in the industry," says Mary Story, director of the Healthy Eating Research National Program at Duke University and a member of the 2015 dietary guidelines committee. Ultimately, the final recommendations from the USDA excluded key suggestions on the consumption of red and processed meats as well as sustainability issues.
Critics are also concerned about the makeup of the committee itself.
The 2020 committee is composed of eminent doctors, registered dieticians and academics with degrees in public health, but many were put forward by and have worked closely with the food industry, according to a Freedom of Information Act document obtained by the Center for Science in the Public Interest that listed which organizations nominated committee members.
Thirteen of the 20 have ties to industry. Several committee members were nominated by four or more food industry groups, from the National Potato Council to National Cattlemen's Beef Association and the trade association of the snack food industry. The majority were nominated by institutes backed by food industry lobby groups, and nine were put forward by the Academy of Nutrition and Dieticians, which has received funding from McDonald's, Coca-Cola and Mars.
According to several experts in the nutrition field, the prevalence of industry ties is far greater than in previous committees. Conflict of interest statements from the 2015 Dietary Guidelines Advisory Committee indicates that only two of 12 members had connections to industry organizations. (No exact comparative document on conflicts of interests is available for the current committee.)
The Food, Nutrition, and Consumer Services staff, which administers the nation's domestic nutrition assistance programs, is also led in this administration by former food industry executives. Chief of staff Maggie Lyon was a former lobbyist for the National Grocers Association and policy adviser Kailee Tkacz was a former lobbyist for the corn syrup and snack food industries. The latter's appointment required an ethical waiver from former White House counsel Donald McGahn, a waiver granting her permission "to participate personally and substantially in matters regarding the Dietary Guidelines for Americans process. "
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Current members of the panel are not permitted to talk to the media about the guidelines process.
When asked about the makeup of the committee, a USDA spokesman said, "The scientists selected to serve on the committee are national leaders in the areas of nutrition and health. . . . Their extensive scientific expertise in their respective fields offers valuable knowledge that will directly benefit the consumers who depend on America's safe, affordable, and nutritious food supply."
